AMIA letter casts broadband as a social determinant of health

The American Medical Informatics Association is calling on Congress to provide some kind of exemption for healthcare uses of the Internet from recently finalized federal rules on net neutrality.

The professional organization this week wrote letters to Reps. Marsha Blackburn (R-Tenn.) and Michael Doyle (D-Pa.), leaders of the House Energy and Commerce committee, which recently held a hearing on the issue of Internet prioritization.

“We’re trying to say that when Congress thinks of policies impacting availability of and cost of broadband, they have to know that care has become digitized,” says Jeff Smith, AMIA’s vice president of public policy. “How we give care has become digital.”

Of particular concern to AMIA are new rules by the Federal Communications Commission that eliminate Obama administration prohibitions on paid prioritization, blocking and throttling of Internet traffic by Internet Service Providers (ISPs).

AMIA’s letter contends that affordable access to broadband Internet means it is now a social determinant of health—thus, the lack of such access can negatively impact patients’ overall health and response to care. Access to broadband Internet has a direct impact on health outcomes, with more care being delivered digitally outside the walls of healthcare providers, AMIA’s letter states.

“People are being empowered to use their devices to manage their care,” Smith notes. “In the near future, it will be more common for doctors to prescribe health apps to download on a phone and those without a phone or Internet will be at a disadvantage.”

Several studies have found that patients who have access to a patient portal have better health status than those who don’t have such access, Smith says. Further, patients of a lower socio-economic level or living in rural areas suffer worse health outcomes.

These factors play into an individual’s social determinants of health, which the World Health Organization defines as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.”

Critics of the new FCC rule have contended that eliminating net neutrality prohibitions will give rise to tiers of service that will disproportionately hurt those who are unable to pay more for broadband access. However, proponents of the FCC rule see it as way to engender competition and innovation, lower costs and lead to expanded broadband coverage.

AMIA’s letter to lawmakers contends that “access to high-speed broadband greatly determines the trajectory of individuals’ health.” Individuals are being empowered and incentivized to use consumer technologies to prevent and manage disease through Internet-connected devices.

The fear, Smith explains, is that under the new FCC rule giant companies that are major content vendors, such as Google, Amazon, Netflix and Facebook, among others, could pay to have their content prioritized by ISPs.

“An ISP that allows Internet traffic to be used for telehealth traffic could affect the content that providers and consumers are looking for. We can envision a future where telehealth has to pay ISPs more money because they just decided to do that and higher costs will result for telehealth. That could exacerbate health disparities,” Smith adds. “Our take on all of this is to ask policymakers to just slow down before you blow up the system.”